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Condition/Disorder Synonyms

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  • Erb's palsy

  • Klumpke's palsy

  • Brachial plexus injury

  • Birth brachial plexus injury

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ICD-9-CM Code1

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ICD-10-CM Codes2

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Preferred Practice Pattern3

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Key Features

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Description

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  • Traumatic injury to the brachial plexus caused during delivery of an infant

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Essentials of Diagnosis

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  • Stretch or incomplete rupture of the plexus is the most common injury often resulting from vacuum or forceps delivery4

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General Considerations

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  • Classifications

    • Upper or Erb's palsy (C5, C6, and/or C7) is the most common: arm postured in shoulder adduction, internal rotation, neutral extension, elbow extension, forearm pronation, wrist and finger flexion

    • Lower or Klumpke's palsy (C8, T1) is rare: hand is flaccid

    • Total palsy (C5-T1): arm and hand involved

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Demographics

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  • About 1.5 per 1,000 infants4

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Clinical Findings

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Signs and Symptoms

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  • Weakness of deltoid, biceps, brachioradialis, brachialis (Erb's palsy)

  • Weakness of wrist flexors and finger intrinsics (Klumpke's palsy)

  • All of the above plus sensory loss for total brachial plexus injury

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Functional Implications

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  • Limits ability to use involved arm for reaching, grasping, or participating in ADLs

  • Inability to weight bear on involved arm

  • Inability to attain quadruped position or creep on hands and knees

  • Asymmetrical use of arms

  • Neglect of involved side

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Possible Contributing Causes

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  • Compression

  • Traction on the shoulder with or without cervical rotation

  • Avulsion

  • Large birth weight

  • Breech presentation5

  • Shoulder dystocia5

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Differential Diagnosis

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  • Spinal cord injury

  • Stroke

  • Cerebral palsy

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Means of Confirmation or Diagnosis

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Imaging

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  • Standard radiograph of arm and chest

  • CT scan

  • MRI

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Diagnostic Procedures

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  • EMG

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Treatment

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Medical Procedures

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  • Surgery for nerve, tendon, or muscle transfers

  • Botox injections to antagonist muscles

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Referrals/Admittance

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  • Neurologist

  • Orthopedist

  • Occupational therapist

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Impairments

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  • Decreased strength

  • Decreased ROM

  • Asymmetrical in and/or delay of gross motor skills

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Tests and Measures

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Intervention

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  • No ROM for 7 to 10-day-old infant5

  • Avoid lying on affected side

  • Avoid picking infant up under axilla

  • Splinting

  • Gentle, ...

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